scholarly journals COVID-19 pandemic is associated with mechanical complications in patients with ST-elevation myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001497
Author(s):  
Satoshi Kitahara ◽  
Masashi Fujino ◽  
Satoshi Honda ◽  
Yasuhide Asaumi ◽  
Yu Kataoka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Late Presentation ◽  
Medical Attention ◽  
Hospital Death ◽  
Mechanical Complication ◽  
St Segment Elevation ◽  
Mechanical Complications ◽  
Before And After ◽  
The Impact

ObjectiveAlthough there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality.MethodsThis single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020.ResultsWe analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p<0.01). Primary PCI was performed significantly less often after the declaration than before (68.3% vs 82.5%, p=0.009). The mechanical complication resulting from STEMI occurred in 13 of 359 (3.6%) patients before the declaration and 9 of 63 (14.3%) patients after the declaration (p<0.001). However, the incidence of in-hospital death (before, 6.2% vs after, 6.4%, p=0.95) was comparable.ConclusionsFollowing the COVID-19 pandemic, an increased incidence of mechanical complications resulting from STEMI was observed. Instructing people to stay at home, without effectively educating them to immediately seek medical attention when suffering symptoms of a heart attack, may worsen outcomes in patients with STEMI.

scholarly journals Clinical features, management and in-hospital outcome of ST elevation myocardial infarction (STEMI) in young adults under 40 years of age

2016 ◽  
Vol 72 (2) ◽  
Author(s):  
Seyed Kianoosh Hosseini ◽  
Abbas Soleimani ◽  
Abbas Ali Karimi ◽  
Saeed Sadeghian ◽  
Sirous Darabian ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Young Patients ◽  
Coronary Intervention ◽  
Clinical Findings ◽  
Hospital Death ◽  
Old Patients ◽  
St Segment Elevation ◽  
History Of

Objectives: This study was designed to evaluate the demographic and clinical findings and in-hospital management and outcome in patients with an acute ST-segment elevation myocardial infarction (STEMI). Material and methods: By review of the Cardiovascular Tehran Heart Center Registry (CVDTHCR), 2028 patients were found to have the acute STEMI. We compared the patients’ characteristics in 109 (5.4%) subjects ≤40 and 1919 subjects &gt; 40 years old. Results: The young patients had less diabetes, hypertension, dyslipidemia and history of MI or prior revascularization, and were more likely to be male (92.7% vs. 74%), smoker (58.7% vs. 31.7%) and have family history of CVD (50.5% vs. 23.4%). The young patients had higher prevalence of angiographically normal coronary artery (13.7% vs. 0.9%; p&lt;0.001). The young patients were more likely to undergo percutaneous coronary intervention (38.5% vs. 18.6%), whereas coronary artery bypass grafting was more common in the old ones (p&lt;0.001). In-hospital death was markedly different among young and old patients (0.9% and 6.1%, respectively; p&lt;0.01). Conclusion: In STEMI population, the risk profile, clinical findings and severity of coronary disease of the young differ substantially from the elderly counterparts. Young patients with STEMI have a favorable outcome compared with that in older patients.

Process mining tools: where should we build another PCI centre to reduce STEMI mortality?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Borges-Rosa ◽  
M Oliveira-Santos ◽  
M Simoes ◽  
C Teixeira ◽  
G Ibanez-Sanchez ◽  
...  
Keyword(s):  
Central Region ◽  
Process Mining ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Funding Source ◽  
St Segment Elevation ◽  
Number Of Patients ◽  
National Model ◽  
Mining Tool ◽  
The Impact

Abstract Introduction The expected delay of transport between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy in ST-segment elevation myocardial infarction (STEMI). The central region of Portugal has heterogeneity in PCI assess due to geographical reasons. However, this data is usually presented numerically without providing a visual distribution of patients. Purpose We aimed to analyse the impact of distance to PCI centres on mortality in patients with STEMI through visual maps of patients' flow by using an experimental process mining tool, integrated in EIT Health's project PATHWAYS. Methods Using the Portuguese Registry of Acute Coronary Syndromes (ProACS), we retrospectively assessed patients with an established diagnosis of STEMI, geographical presentation specified, reperfusion option identified (PCI, fibrinolysis or no reperfusion), short-term outcomes defined as discharge or in-hospital death. With the 2 317 patients that fulfilled the criteria, we used a process mining tool to build national and regional models that represent the flow of patients in a healthcare system, enhancing differences between groups. Results Colour gradient in nodes and arrows changes from green to red, with green representing a lower number of patients as opposed to red. In the national model, most patients from all regions had PCI. Mortality was similar between PCI and fibrinolysis groups (4%) but higher in those without reperfusion (9%). In the central region model, one third of the patients were more than 120 minutes away from a PCI centre. Despite that, almost one third of these patients had PCI instead of fibrinolysis. In this model, fibrinolytic therapy had higher in-hospital survival rate than PCI (98% vs. 94%). Overall mortality was higher in the central model compared with the national model (6.92% vs. 5%). Central region had less PCI (53% vs. 73%), more fibrinolysis (15% vs. 7%) and more patients with no reperfusion (32% vs. 20%). Conclusion In the ProACS registry, mortality was higher in the central region compared with national data. Even though global interpretation of these findings is limited by underrepresentation from certain central areas, process mining offers an easily understandable view of patients flow. With its statistical upgrade and continuous development, this tool will facilitate the analysis of big data and comparison between groups. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): EIT Health

scholarly journals The Impact of COVID-19 on In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients

2021 ◽  
Vol 10 (2) ◽  
pp. 278
Author(s):  
Sherif Ayad ◽  
Rafik Shenouda ◽  
Michael Henein
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Coronary Intervention ◽  
Control Group ◽  
St Segment Elevation ◽  
Clinical Procedures ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Impact

Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on in-hospital clinical outcome of ST elevation myocardial infarction (STEMI) patients managed with PPCI. This observational retrospective study was conducted on consecutive STEMI patients who presented to the International Cardiac Center (ICC) hospital, Alexandria, Egypt between 1 February and 31 October 2020. A group of STEMI patients presented during the same period in 2019 was also assessed (control group) and data was used for comparison. The inclusion criteria were established diagnosis of STEMI requiring PPCI.A total of 634 patients were included in the study. During the COVID-19 period, the number of PPCI procedures was reduced by 25.7% compared with previous year (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and the time from first medical contact to Needle (FMC-to-N) was longer (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001). Also, during COVID-19, the in-hospital mortality was higher (7.4 vs. 4.6%, p = 0.036) as was the incidence of re-infarction (12.2 vs. 7.7%, p = 0.041) and the need for revascularization (15.9 vs. 10.7%, p = 0.046). The incidence of heart failure, stroke, and bleeding was not different between groups, but hospital stay was longer during COVID-19 (6.85 ± 4.22 vs. 3.5 ± 2.3 day, p = 0.0025). Conclusion: At the ICC, COVID-19 pandemic contributed significantly to the PPCI management of STEMI patients with decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay.

scholarly journals Impact of acute infarct-related artery patency before percutaneous coronary intervention on 30-day outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention in the EUROMAX trial

2017 ◽  
Vol 7 (6) ◽  
pp. 514-521 ◽  
Author(s):  
Tomasz Rakowski ◽  
Dariusz Dudek ◽  
Arnoud van ’t Hof ◽  
Jurrien Ten Berg ◽  
Louis Soulat ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Infarct Related Artery ◽  
The Impact

Aims: Early infarct-related artery patency has been associated with improved outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. However, it is unknown whether this relationship persists in contemporary practice with pre-hospital initiation of treatment, use of novel P2Y12 inhibitors and frequent use of drug-eluting stents. The purpose of the study was to determine the impact of early infarct-related artery patency on outcomes in the contemporary EUROMAX trial. Methods and results: A total of 2218 patients were enrolled. The current analysis was done on 1863 patients who underwent percutaneous coronary intervention and had infarct-related artery patency data. Thirty-day outcomes were compared according to infarct-related artery flow before percutaneous coronary intervention (Thrombolysis in Myocardial Infarction (TIMI) flow 0/1 vs. TIMI flow 2/3), and interaction with antithrombotic strategy was examined. A patent infarct-related artery (TIMI flow 2/3) was present in 707 patients (37.9%) and was associated with a higher rate of final TIMI 3 flow grade (98.9 vs. 92.6%; p<0.001). At 30 days, a patent infarct-related artery was associated with lower rates of cardiac death (1.3% vs. 2.9%; p=0.026) and the composite of death or myocardial infarction (2.7% vs. 4.6%; p=0.039). There were no interactions between antithrombotic treatment and the impact of infarct-related artery patency on cardiac death, myocardial infarction, or the composite of death or myocardial infarction (Breslow–Day interaction p-values of 0.21, 0.33 and 0.46, respectively). Conclusion: Despite evolution in primary percutaneous coronary intervention strategies, early infarct-related artery patency is still associated with higher procedural success and improved clinical outcomes. The choice of antithrombotic strategy did not interact with the benefits of a patent infarct-related artery at presentation.

scholarly journals Successful Percutaneous Device Closure of Ventricular Septal Rupture in a Patient with Acute Anterior Wall Myocardial Infarction and Cardiogenic Shock

2019 ◽  
pp. 1-5
Author(s):  
Gurkirat Singh ◽  
Mahesh Bodkhe ◽  
Akshat Jain ◽  
Narender Omprakash Bansal
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Coronary Intervention ◽  
Anterior Wall ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
St Segment Elevation ◽  
Peripheral Hospital ◽  
Septal Occluder Device ◽  
Anterior Wall Myocardial Infarction

Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of acute myocardial infarction. The incidence of VSR has decreased from 1-3% following ST-segment elevation myocardial infarction in the pre-reperfusion era to 0.17-0.31% following primary percutaneous coronary intervention. Survival to 1 month without intervention is 6%. We report a case of a 60-year-old male, admitted in a peripheral hospital with acute anterior wall myocardial Infarction. He was thrombolized with streptokinase. He developed breathlessness at rest and shifted to our hospital for further management. On evaluation in intensive care unit found to have VSR. The patient was in cardiogenic shock. The ventricular septal rupture was successfully closed with a septal occluder device. After which the patient stabilized hemodynamically and was discharged after 8 days.

Can Thrombus Burden Predict Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction?

Angiology ◽  
2019 ◽  
Vol 70 (7) ◽  
pp. 642-648 ◽  
Author(s):  
Serhat Sigirci ◽  
Kudret Keskin ◽  
Süleyman Sezai Yildiz ◽  
Gökhan Cetinkal ◽  
Ahmet Gurdal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Impact

The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden <TG 4 was defined as small thrombus burden. A total of 126 (14.2%) patients with STEMI had CIN, while 313 (35.4%) patients had LTB. Compared to CIN (−) patients, CIN (+) patients were older, had lower hemoglobin levels, lower ejection fraction, and higher contrast media volume administration. Multivariate logistic regression analysis demonstrated that LTB, age, hypertension, and admission glomerular filtration rate were independent predictors of CIN ( P = .016, P < .001, P = .028, P < .001, respectively). Thrombus burden, which is measurable during angiography, may be helpful in the determination of CIN risk in patients with STEMI.

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